Management of pyoderma gangrenosum with combination of systemic treatment, vacuum-assisted closure and synthetic dermal substitute

Abstract

Pyoderma gangrenosum (PG) is a destructive, necrotizing cutaneous process where surgical debridement can produce 'pathergy' phenomenon. Actually, an accepted strategy is to control the disease medically and follow-up with delayed surgical intervention with a split-thickness skin grafting after prolonged courses of immunosuppressive therapy. We report two cases of pretibial PG, one of them a complicated case of a 23 year-old woman with ulcerative colitis and a huge PG which was successfully treated with a synergistic approach utilizing a sequential protocol with systemic treatment, surgical debridement, antimicrobial silver dressing (Acticoat®), vacuum-assisted closure (VAC) therapy and a double layer of synthetic dermal substitute (Integra®) with a skin graft. A systematic review of the literature displays no previous cases utilizing this combined approach. Rare case reports have described VAC therapy use in the management of PG, and only one has described Integra® use. In both cases, rebuilding of the scaffolding were achieved, there was no evidence of recurrence of PG, the cosmetic results were overall satisfactory without limitation of movement for extension and flexion of the foot. Level of Evidence: Level V, therapeutic study.

DOI: 10.1007/s00238-015-1147-5

6 Figures and Tables

Statistics

02004006008002017
Citations per Year

72 Citations

Semantic Scholar estimates that this publication has 72 citations based on the available data.

See our FAQ for additional information.

Cite this paper

@article{NovoTorres2015ManagementOP, title={Management of pyoderma gangrenosum with combination of systemic treatment, vacuum-assisted closure and synthetic dermal substitute}, author={Ashley Novo-Torres and Francisco Javier C{\'e}spedes-Guirao and Nozay Guzm{\'a}n Restituyo and Elena Lorda-Barraguer}, journal={European Journal of Plastic Surgery}, year={2015}, volume={39}, pages={297-302} }